Huenges Wajer Irene M C, Visser-Meily Johanna M A, Greebe Paut, Post Marcel W M, Rinkel Gabriel J E, van Zandvoort Martine J E
a Department of Neurology and Neurosurgery, Rudolf Magnus Institute for Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands.
b Center of Excellence in Rehabilitation Medicine, Rehabilitation Center De Hoogstraat and Rudolf Magnus Institute for Neuroscience , University Medical Center Utrecht , Utrecht , The Netherlands.
Top Stroke Rehabil. 2017 Mar;24(2):134-141. doi: 10.1080/10749357.2016.1194557. Epub 2016 Jun 20.
Most survivors of an aneurysmal subarachnoid hemorrhage (aSAH) are ADL-independent, but they often experience restrictions in (social) activities and, therefore, cannot regain their pre-morbid level of participation.
In this study, participation restrictions and participation satisfaction experienced after aSAH were assessed. Moreover, possible predictors of participation after aSAH were examined to identify goals for rehabilitation.
Participation restrictions experienced by a series of 67 patients visiting our SAH outpatient clinic were assessed as part of standard clinical care using the Participation Restrictions and Satisfaction sections of the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-Participation) 6 months after aSAH. Cognitive impairments, cognitive and emotional complaints, and symptoms of depression and anxiety, assessed 10 weeks after aSAH, were examined as possible predictors of participation by means of linear regression analysis.
Although patients were ADL-independent, 64% reported one or more participation restrictions and 60% were dissatisfied in one or more participation domains. Most commonly experienced restrictions concerned housekeeping, chores in and around the house, and physical exercise. Dissatisfaction was most often reported about outdoor activities, mobility, and work/housekeeping. The main predictors of participation restrictions as well as satisfaction with participation were cognitive complaints (subjective) (β = -.30, p = .03 and β = -.40, p = .002, respectively) and anxiety (β = .32, p = .02 and β = -.34, p = .007, respectively).
Almost two-thirds of the ADL-independent patients experienced problems of participation 6 months after aSAH. Cognitive complaints (subjective) and anxiety symptoms showed the strongest association with participation restrictions and satisfaction. Cognitive rehabilitation and anxiety-reducing interventions may help to optimize rehabilitation and increase participation after aSAH.
大多数动脉瘤性蛛网膜下腔出血（aSAH）幸存者日常生活活动（ADL）能够自理，但他们在（社交）活动中常受到限制，因此无法恢复病前的参与水平。
本研究评估了aSAH后经历的参与限制和参与满意度。此外，还研究了aSAH后参与的可能预测因素，以确定康复目标。
作为标准临床护理的一部分，使用乌得勒支康复参与评估量表（USER-参与）的参与限制和满意度部分，对67例前来我院SAH门诊就诊的患者在aSAH后6个月时经历的参与限制进行评估。在aSAH后10周评估的认知障碍、认知和情绪主诉以及抑郁和焦虑症状，通过线性回归分析作为参与的可能预测因素进行研究。
尽管患者ADL能够自理，但64%报告有一项或多项参与限制，60%在一个或多个参与领域不满意。最常经历的限制涉及家务、房屋内外杂务和体育锻炼。最常报告不满意的是户外活动、行动能力和工作/家务。参与限制以及参与满意度的主要预测因素分别是认知主诉（主观）（β = -0.30，p = 0.03和β = -0.40，p = 0.002）和焦虑（β = 0.32，p = 0.02和β = -0.34，p = 0.007）。
几乎三分之二ADL能够自理的患者在aSAH后6个月出现参与问题。认知主诉（主观）和焦虑症状与参与限制和满意度的关联最强。认知康复和减轻焦虑的干预措施可能有助于优化康复并增加aSAH后的参与度。
